Legislature(1997 - 1998)

03/09/1998 09:06 AM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
      SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE                   
                          March 9, 1998                                        
                            9:06 a.m.                                          
                                                                               
MEMBERS PRESENT                                                                
                                                                               
Senator Gary Wilken, Chairman                                                  
Senator Loren Leman, Vice-Chairman                                             
Senator Lyda Green                                                             
Senator Jerry Ward                                                             
Senator Johnny Ellis                                                           
                                                                               
MEMBERS ABSENT                                                                 
                                                                               
None                                                                           
                                                                               
COMMITTEE CALENDAR                                                             
                                                                               
SENATE BILL NO. 331                                                            
"An Act regulating licensed professional counselors; regulating use            
of the titles 'licensed professional counselor' and 'licensed                  
counselor'; amending Rule 504(a)(3), Alaska Rules of Evidence; and             
providing for an effective date."                                              
     HEARD AND HELD                                                            
                                                                               
SENATE BILL NO. 321                                                            
"An Act relating to assisted living homes."                                    
     MOVED CSSB 321(HES) OUT OF COMMITTEE                                      
                                                                               
PREVIOUS SENATE COMMITTEE ACTION                                               
                                                                               
SB 331 - No previous Senate committee action.                                  
                                                                               
SB 321 - No previous Senate committee action.                                  
                                                                               
WITNESS REGISTER                                                               
                                                                               
Beth Hagevig                                                                   
Staff to Senator Wilken                                                        
Alaska State Capitol                                                           
Juneau, Alaska  99801-1182                                                     
POSITION STATEMENT:  Testified for the sponsor of SB 331                       
                                                                               
Ann Henry                                                                      
3347 Park Place                                                                
Juneau, Alaska  99801                                                          
POSITION STATEMENT:  Supports SB 331                                           
                                                                               
Pamela Watts                                                                   
American Counseling Association of Alaska                                      
P.O. Box 240554                                                                
Douglas, Alaska  99824                                                         
POSITION STATEMENT:  Supports SB 331                                           
                                                                               
Robert Pound                                                                   
Southcentral Counseling Center                                                 
3725 Spinnaker Drive                                                           
Anchorage, Alaska                                                              
POSITION STATEMENT:  Supports SB 331                                           
                                                                               
Allan Morotti                                                                  
Alaska School Counselors' Assn.                                                
791 Goldstreak Road                                                            
Fairbanks, Alaska  99712                                                       
POSITION STATEMENT:                                                            
                                                                               
Dixie Hood                                                                     
222 Seward St., Suite 210                                                      
Juneau, Alaska  99801                                                          
POSITION STATEMENT:  Supports SB 331                                           
                                                                               
SENATOR MIKE MILLER                                                            
Alaska State Capitol                                                           
Juneau, Alaska  99081-1182                                                     
POSITION STATEMENT:  Sponsor of SB 321                                         
                                                                               
John Pierce                                                                    
430 4th Street                                                                 
Fairbanks, Alaska  99701                                                       
POSITION STATEMENT:  Supports SB 321                                           
                                                                               
Dwight Becker                                                                  
Division of Senior Services                                                    
Department of Administration                                                   
3601 C Street, Room 310                                                        
Anchorage, Alaska  99503                                                       
POSITION STATEMENT: Supports SB 321                                            
                                                                               
Rose Heyano                                                                    
Bristol Bay Native Association                                                 
P.O. Box 310                                                                   
Dillingham, Alaska  99576                                                      
POSITION STATEMENT:  Supports SB 321                                           
                                                                               
Cathy Westling                                                                 
329 D Street                                                                   
Fairbanks, Alaska  99701                                                       
POSITION STATEMENT:  Supports SB 321                                           
                                                                               
Monta Lane                                                                     
109 E 5th Street                                                               
North Pole, Alaska  99705                                                      
POSITION STATEMENT:  Supports SB 321                                           
                                                                               
Debbie Cask                                                                    
3291 Jefferson Drive                                                           
Fairbanks, Alaska 99709                                                        
POSITION STATEMENT:  Supports SB 321                                           
                                                                               
Helen Powell                                                                   
1913 Jack Street                                                               
Fairbanks, Alaska  99709                                                       
POSITION STATEMENT:  Supports SB 321                                           
                                                                               
Sharon Kenamon                                                                 
2106 Flight Street                                                             
North Pole, Alaska  99705                                                      
POSITION STATEMENT: Supports SB 321                                            
                                                                               
Judith Townsend                                                                
120 Pepperdine Drive                                                           
Fairbanks, Alaska  99709                                                       
POSITION STATEMENT: Supports SB 321                                            
                                                                               
Derrill Johnson                                                                
Department of Health & Social Services                                         
P.O. Box 110620                                                                
Juneau, Alaska  99811-0620                                                     
POSITION STATEMENT:  Commented on SB 321                                       
                                                                               
Sharon Clark                                                                   
Legislative Aide to Senator Mike Miller                                        
Alaska State Capitol                                                           
Juneau, Alaska  99801-1182                                                     
POSITION STATEMENT: Commented on SB 321                                        
                                                                               
ACTION NARRATIVE                                                               
                                                                               
TAPE 98-22, SIDE A                                                             
Number 001                                                                     
                                                                               
CHAIRMAN WILKEN called the Senate Health, Education and Social                 
Services (HESS) Committee to order at 9:06 a.m.  Present were                  
Senators Wilken, Leman, Ward, and Green.  CHAIRMAN WILKEN announced            
the committee was waiting for a committee substitute for SB 321 to             
arrive, therefore SB 331 would be heard first.                                 
                                                                               
           SB 331 - PROFESSIONAL COUNSELOR LICENSING                           
                                                                               
CHAIRMAN WILKEN informed committee members a new draft version of              
SB 331 was prepared (version B).                                               
                                                                               
SENATOR WARD moved to adopt CSSB 331 (version B) as the working                
document of the committee.  There being no objection, the motion               
carried.                                                                       
                                                                               
BETH HAGEVIG, legislative aide to Senator Wilken, gave the                     
following explanation of the measure.  CSSB 331 establishes a board            
to license and regulate experienced Masters and Doctoral level                 
professional counselors whose education and experience do not fall             
within the existing behavioral health specializations of Licensed              
Clinical Social Worker, Licensed Marriage and Family Therapist,                
Psychologist, or Psychological Associate.  This bill benefits                  
counselors because it opens doors to employee assistance programs              
that currently require that service providers be licensed to                   
qualify for their programs; it broadens career opportunities for               
counselors who wish to work for entities that require licensure; it            
provides incentive for Masters level behavioral health graduates of            
Alaska's university system to stay in state and take advantage of              
licensing opportunities that already exist in 44 other states; and             
it includes licensed professional counselors under Rule 504,                   
protecting them from contempt of court, in cases where client                  
confidentiality must be protected.                                             
                                                                               
MS. HAGEVIG explained CSSB 331 is good for Alaska's consumers                  
because it establishes a minimum standard of education and                     
experience that clients can trust, eliminating the buyer beware                
situation that currently exists.  It institutes grievance                      
procedures and gives legal recourse for clients of licensed                    
professional counselors who feel they have been victims of                     
fraudulent, unethical, or negligent practices.  It gives clients,              
who require mental health services, greater choice and comfort in              
choosing a provider that best suits their needs, both emotionally              
and financially, and it increases the availability of licensed                 
mental health providers who practice statewide, giving rural                   
residents better access to mental health care.  This bill has the              
support of the American Counseling Association (ACA),  the ACA of              
Alaska, the Alaska School Counselor Association, numerous                      
professional counselors and clients.                                           
                                                                               
Number 082                                                                     
                                                                               
CHAIRMAN WILKEN pointed out a two-page document in committee                   
members' packets shows where Alaska fits into the scheme of                    
counselor licensing nationwide.  The remainder of the packet                   
contains letters of support.                                                   
                                                                               
SENATOR LEMAN noted SB 122, dealing with family and marriage                   
counselors, is currently in the House.  He asked Ms. Hagevig if any            
thought was given to combining the counseling and marriage and                 
family therapy boards into a common board, instead of creating a               
new board.  He commented he serves on a professional board made up             
of architects, engineers and land surveyors, and although the                  
professions differ, their common board is able to take care of the             
professional interests of all three groups.                                    
                                                                               
MS. HAGEVIG replied the counselors support combining the boards                
and are working with the marriage and family therapists' board                 
members on creating a joint board.  She suggested asking Pamela                
Watts and Ann Henry, from the American Counseling Association of               
Alaska, to address that question.                                              
                                                                               
Number 122                                                                     
                                                                               
ANN HENRY, a member of the American Counseling Association of                  
Alaska (ACAA), gave the following testimony.  SB 331 is a title                
restriction bill, rather than a practice restriction bill, which               
means that people can continue to practice counseling in Alaska if             
they are practicing now.  That arrangement will especially benefit             
the bush areas where counselors might now be practicing without the            
required education.  Nationally, 44 states have some kind of                   
licensure certification and 80,000 licensed professional counselors            
are nationally recognized.  As a private practitioner, clients are             
often referred to her, but because she is not a licensed                       
practitioner, employee assistance programs will not provide                    
insurance coverage for her services.  Managed care programs also               
require licensure.  Ms. Henry believes clients need to be able to              
choose their counselor.                                                        
                                                                               
MS. HENRY noted that in regard to Senator Leman's question about               
combining the two boards, the marriage and family therapists' board            
supports SB 331 and discussed, at its last meeting, the need to                
speak to ACAA about the possibility of combining the boards.  The              
ACAA definitely favors combining the boards.  She assumed that                 
counselors will not be a viable group for the family and marriage              
therapists' board to deal with until they get licensing                        
certification in Alaska.                                                       
                                                                               
Number 172                                                                     
                                                                               
PAM WATTS, President of the American Counseling Association of                 
Alaska, gave the following testimony.  When ACAA began efforts to              
require counselor licensure, it heard from several University of               
Alaska graduates who were having difficulty obtaining and                      
maintaining employment or advancing in their positions.  They                  
support licensure because the lack of licensure requirements is                
limiting employment opportunities for them after they graduate.  A             
second issue is that hundreds of Masters and Doctoral level                    
counselors are currently providing counseling services around the              
state.  ACAA is concerned that without licensure, they will not be             
able to practice, and in some cases, they are the only people                  
available in those areas to do this work.  Because they are trained            
to provide a range of counseling services that are not necessarily             
limited to the specialty licenses that Alaska currently has, such              
as marriage and family, or psychology or social work, they do not              
fit anywhere in the licensure scheme.  SB 331 offers consumer                  
protection, easier access to mental health services, and will                  
provide Alaskans the opportunity to pursue occupations within the              
state for which they have been trained.                                        
                                                                               
MS. WATTS reiterated that ACAA is interested in looking at                     
combining with the marriage and family therapists' board.  She                 
agreed that closely related fields can function very well on                   
combined boards.  She pointed out that other states, such as                   
Georgia, have an omnibus board that includes social workers,                   
chemical dependency counselors, licensed professional counselors               
and marriage and family therapists.  She thought creating a similar            
board in Alaska in the future would be fiscally responsible.                   
                                                                               
Number 227                                                                     
                                                                               
SENATOR LEMAN encouraged Ms. Watts to further the dialogue about               
combining the two boards because he thought SB 331 would be a good             
vehicle in which to do so this year.  He advised that if they do               
not combine boards, counselors will incur all of the initial costs             
of establishing a separate board which will increase the fees.                 
                                                                               
CHAIRMAN WILKEN asked about the status of SB 122.                              
                                                                               
SENATOR LEMAN stated it is in the House and he believes it is                  
scheduled to pass.                                                             
                                                                               
ROBERT POUND, a counselor with Southcentral Counseling Center in               
Anchorage, testified in support of SB 331.  The Southcentral                   
Counseling Center has developed a system in which a person must be             
licensed to reach the highest level of clinician.  SB 331 would                
enable him to obtain a license and become a senior clinician.                  
Without a licensing requirement in Alaska, agencies are forced to              
find people outside of the state to fill these positions.                      
Requiring experience and education will ensure better quality                  
treatment to clients.  He received a professional counselor license            
in the State of Colorado around 1989.  That license allowed him to             
do contract work, EAP work, and to have a private practice.  The               
certification process requires a disclosure statement to be filled             
out by clients.  He found clients responded very positively and the            
ability to do so relieved clients of worry.  Mr. Pound believed SB
331 will have positive results on both counselors and consumers.               
                                                                               
Number 308                                                                     
                                                                               
ALLAN MOROTTI, representing the Alaska School Counselors'                      
Association, and the counseling program at the University of Alaska            
Fairbanks, gave the following testimony.  The Alaska School                    
Counselors' Association supports SB 331.  Many rural counselors                
feel that passage of SB 331 will improve the delivery of mental                
health services.  Students from the UAF program who end up                     
counseling in rural areas often find themselves functioning in the             
role of a crisis counselor.  As they move from site to site, the               
majority of their work is dealing with crisis issues, rather than              
the more traditional school counseling issues.  Passage of SB 331              
will allow those counselors to get the additional supervision                  
necessary to provide quality mental health services, and passage               
will allow many of UAF's graduates to move out into the mental                 
health agencies. Once employed by those agencies, the graduates                
feel pressured to acquire some type of licensure.  Many agencies               
hire out-of-state because of the lack of licensed practitioners in             
the state.  He believes the course work for Masters level                      
counselors nationwide, in the area of supervision, clinical hours,             
diagnosis and appraisal, compares favorably with the requirements              
for clinical social workers and marriage and family therapists.  He            
concluded by saying he strongly supports the bill both as an                   
individual and on behalf of the Alaska School Counselors'                      
Association.                                                                   
                                                                               
Number 371                                                                     
                                                                               
CHAIRMAN WILKEN asked Mr. Morotti his opinion of combining the                 
counselors' board with the marriage and family therapists' board.              
                                                                               
MR. MOROTTI said he thinks it is a good idea because he sees no                
need to have a proliferation of boards providing mental health                 
services.                                                                      
                                                                               
DIXIE HOOD, a licensed marriage and family therapist from Juneau,              
and a member of the Board of Marital and Family Therapy, gave the              
following testimony.  As a 23 year Alaska resident and psychology              
professor at the University of Alaska Southeast, she moved to                  
California to complete a Masters in Counseling program for two                 
years.  That program required 3,000 supervised hours and an oral               
and written exam.  She was licensed in California and upon                     
returning to Juneau in 1985, contacted the Division of Occupational            
Licensing to find out what requirements she needed to meet to                  
practice.  Purchase of a business license was the only requirement             
until 1992.  She commented that marriage and family therapy is not             
a specialty field.  It is a theoretical approach in terms of                   
counseling individuals, couples, or family members within the                  
family systems approach and their interrelationships.  Marriage and            
family therapists also treat people with alcohol problems, serious             
chronic mental illness, and depression and anxiety.                            
                                                                               
MS. HOOD indicated at the February 10, 1998 Marital and Family                 
Therapy Board meeting, the Board expressed interest in supporting              
standards and licensure for professional counselors in Alaska, and             
in discussing with them consideration of a combined board.  The                
board has sought information from other states with omnibus boards             
to find out how their systems work.                                            
                                                                               
MS. HOOD commented she has testified on and followed SB 122; it is             
scheduled before the House Labor and Commerce Committee this                   
afternoon for a second hearing.  During the first hearing, held                
last week, information was requested and an amendment was                      
discussed.  The same amendment failed the Senate last year and                 
would have added licensed marriage and family therapists to a list             
of health care providers who cannot be discriminated against in                
third party reimbursements.  MS. HOOD believes it is important for             
consumers to have some trust in the amount of training and                     
experience required of mental health providers.  Licensure                     
requirements are also important for the professional in terms of               
standing in the professional community and employee assistance                 
programs and insurance companies.                                              
                                                                               
SENATOR LEMAN noted his memory of what happened regarding the                  
amendment differed from Ms. Hood's.  He recalled the amendment                 
passed the Senate but its passage created challenges in the bill               
that some did not want to address at the time, therefore the                   
amendment was removed and the bill passed.                                     
                                                                               
MS. HOOD added the amendment created a furor from chiropractors,               
dentists and other professionals.  The Omnibus Insurance Reform Act            
did not take up that amendment, therefore the Board of Marital and             
Family Therapy is hoping it will be taken up in SB 122 or in                   
another venue.                                                                 
                                                                               
There being no further testimony on SB 331, CHAIRMAN WILKEN                    
announced the committee would hold the bill to investigate whether             
it can be incorporated into SB 122 or vice versa.                              
                                                                               
SENATOR LEMAN stated whether SB 122 is the right vehicle in which              
to combine the boards or not, he thought the Legislature should                
consider combining the two boards and use a separate piece of                  
legislation if necessary.                                                      
                                                                               
CHAIRMAN WILKEN indicated the bill would be brought before the                 
committee on Wednesday and a report on SB 122 would be provided.               
                                                                               
              SB 321 - ASSISTED LIVING FACILITIES                              
                                                                               
CHAIRMAN WILKEN announced a committee substitute had been prepared             
for SB 321.                                                                    
                                                                               
SENATOR WARD moved to adopt CSSB 321 (version F) as the working                
document of the committee.  There being no objection, the motion               
carried.                                                                       
                                                                               
SENATOR MIKE MILLER, District Q, discussed the reason he introduced            
SB 321.  His father was placed in an assisted living care facility             
in North Pole as a private pay client.  Through the course of his              
father's stay, the family saw the type of loving care given to his             
father until he passed away and to the other clients.  One other               
client was a private pay; the other clients were paid for by the               
state for which the caregiver received $34.50 per day.  Senator                
Miller cautioned that if the current amount paid to assisted living            
caregivers is not increased, more and more caregivers will quit                
providing services because the care provided in these homes is very            
demanding upon the caregivers.  If fewer caregivers are available,             
families will have to send elderly relatives to places like Denali             
Center, which costs the state a couple of hundred dollars per day.             
Assisted living facilities are a less expensive alternative, and               
they provide a different type of environment which some people                 
prefer.                                                                        
                                                                               
SENATOR MILLER maintained he was not sure how the increased cost               
associated with SB 321 will be paid, but he felt dialogue on long              
term care issues must begin.  He concluded by saying he cannot                 
speak highly enough about the caregivers who provide this service              
and the type of care his father received and he believes increasing            
the amount of funds they receive is the right thing to do.                     
                                                                               
CHAIRMAN WILKEN questioned how the $70 amount was calculated.                  
                                                                               
SENATOR MILLER replied his staff worked with a number of assisted              
living caregivers to come up with that number. Since the last                  
increase in 1983, many expenses have increased, such as insurance              
rates.                                                                         
                                                                               
CHAIRMAN WILKEN asked if assisted living homes require licensure               
and if they take more than one client at a time.                               
                                                                               
SENATOR MILLER answered this particular home was licensed by the               
State of Alaska to house up to five individuals at a time.  He                 
added that private pay clients go to the top of the waiting list               
because they pay more.  His father's care cost $100 per day, but               
had he been in an institution, the cost would have been much                   
higher.  He noted a number of the individuals who live in assisted             
living facilities do so until they pass on.                                    
                                                                               
CHAIRMAN WILKEN pointed out that Mr. Kohn of the Pioneer Home                  
estimated there will be 30,000 s and enter an educational                      
institutional setting eniors in the State of Alaska in the year                
2000 or 2005 while only be 600 Pioneer Home beds will be available.            
                                                                               
Number 552                                                                     
                                                                               
JOHN PIERCE, Vice President of Senior Quality Care Incorporated,               
which owns and operates an eight-bed facility named "Summer Shade,"            
made the following remarks.  One cannot even find a good motel room            
in Fairbanks for $34.50, yet assisted living facilities offer 24               
hours per day of care for that amount.  In his facility everyone is            
licensed as at least a CNA.  His clients need various levels of                
care; some need borderline nursing home services; some are taken in            
emergency situations.  The paperwork submitted for clients who                 
qualify for state monies normally takes 60 to 90 days to process.              
He asked that the amount of payment be dependent upon the level of             
care needed.   Mr. Pierce thought assisted living facilities are               
competing unfairly with Pioneers Homes because Pioneers Homes do               
not accept clients for $34.50 per day.  After he does the paperwork            
for some of his clients, and their health improves, they are often             
transferred to a Pioneer Home.                                                 
                                                                               
TAPE 98-22, SIDE B                                                             
Number 580                                                                     
                                                                               
DWIGHT BECKER, Program Coordinator with the Division of Senior                 
Services, stated he supervises programs of adult protection and                
assisted living facility licensing, and he administers the general             
relief program statewide.  He maintained assisted living providers             
are a very important part of the senior services network.  They do             
not only provide services for seniors, they also provide services              
to anyone 18 years of age and over who is a vulnerable adult with              
a mental or physical impairment.  He believes providers are long               
overdue for some type of increase.  The clientele they are now                 
serving are becoming more difficult to provide for.  More clients              
have mental health problems, alcohol and substance abuse related               
problems, and are violent.  Many clients have multiple health care             
needs requiring a whole array of services.  In Alaska the assisted             
living providers market rate for taking care of such clients runs              
about $2500 to $3000 per month.  The general relief program pays a             
base rate of $30 in Anchorage; a cost of living differential is                
applied to other areas around the state.  He supports some type of             
increase.  Everyday, his agency receives calls from hospital                   
discharge planners, police departments, and others looking for                 
facilities in which to place people who are at risk of becoming                
homeless and/or are at risk of abuse, neglect, or self-neglect.                
Alaska has almost 100 assisted living homes statewide, and rarely              
do they refuse to take a client, even at the low rates.                        
                                                                               
Number 550                                                                     
                                                                               
ROSE HEYANO, the social services director for the Bristol Bay                  
Native Association (BBNA), informed committee members that BBNA is             
currently assisting in the development of a ten bed facility to be             
located in Dillingham.  Funding for that facility is contained in              
the senior citizen housing development fund in the Governor's                  
capital budget request.  BBNA is relying on medicaid choice funds              
and the daily base rate paid by DHSS for adults in residential care            
for this operation.  This funding is not adequate to make the                  
facility self sufficient.  BBNA needs at least $1400 per month per             
client to be self-supporting.  The goal of the region is to develop            
a ten-bed facility in Dillingham and then smaller facilities in                
Togiak and New Stuyahok.  BBNA found that in 1996, 16 elders left              
the region, yet everyone of them could have been placed in assisted            
facilities if the space was available.  Local residents want to                
keep their elderly relatives close by.  BBNA estimates that nine               
out of 10 beds will be filled by low-income people on fixed                    
incomes.  The operational costs in rural Alaska are much higher                
than in urban areas.  BBNA determined from a survey it conducted               
last year there are 80 elders in the region.  It currently has a               
home care program that has placed over 50 personal care attendants             
in over 70 elders' homes in the region.  An assisted living                    
facility will provide one more level of care for elders who need to            
make that transition.  It will be less expensive in the long run to            
keep elders closer to home.  MS. HEYANO encouraged committee                   
members to help BBNA in its endeavor to develop more assisted                  
living facilities in its region.                                               
                                                                               
CATHY WESTLING, representing Downtown Care Assisted Living, and the            
secretary of the Alaska Caregivers' Association, stated that                   
assisted living is a model of care in the State of Alaska.                     
Essentially, foster care turned into assisted living two to three              
years ago.  Caregivers are a self-governing body of independent                
business owners who are required to be licensed, monitored and                 
accountable.  The goal of assisted living is to deinstitutionalize             
care as long as possible; assisted living caregivers need                      
recognition and support.  These business owners are required to pay            
insurance and workers' compensation, yet the base rate has not                 
changed since 1983.   Downtown Care Assisted Living is a ten-bed               
facility that employs seven employees: often native employees,                 
employees off of welfare roles, and employees who are related to               
clients.  It has housed many displaced elders who come from rural              
areas to Anchorage for medical care.  Ms. Westling indicated that              
many of her clients have alcohol and substance abuse problems,                 
and/or have been abused and exploited.  These clients need help                
learning how to deal with relationships.  She gets involved in                 
restraining orders, guardianship issues, probate court, and getting            
people into counseling. Clients in assisted living facilities need             
care 24 hours per day.  With a higher base rate for clients, she               
would like to hire more escorts to get clients active in the                   
community.  She added the State of Washington pays $55 per day as              
its base rate.                                                                 
                                                                               
MS. WESTLING indicated she has many clients with mental health and             
developmental disability problems.  These clients can be very                  
disruptive and sometimes it takes up to one year to receive funding            
for those clients.  She believes the homeless population with                  
mental illness or developmental disabilities will suffer the most              
if the rates are not raised.                                                   
                                                                               
MONTA LANE, owner of a five-bed facility in North Pole, and                    
President of Alaska Caregivers' Association, thanked Senator Miller            
for his efforts and made the following statements.  She started her            
business in 1991, which was known as adult foster care at that                 
time.  The rate of pay in 1991 for general relief clients was                  
$30.91; the amount increased by $2.60 in 1992.  Nursing homes are              
not designed to take care of people who have reached a point to                
where they need to be in an assisted living type of setting.  As               
clients get older, they usually deteriorate and often die in the               
assisted living facility.  Clients become part of a family, and it             
is difficult to lose them.  Regarding the question about the                   
increase to $70 per day, Ms. Lane said she originally requested                
$100 per day with a sliding fee for people who require more care.              
She has detoxed clients.  The Legislature appropriated $21 million             
for alcohol and substance abuse problems, yet none of that money is            
available to assisted living homes or the adult protection agency.             
Almost every assisted living home in the Interior has alcohol                  
related dementia seniors in their homes.  Ms. Lane emphasized                  
assisted living facility owners work 24 hours per day yet they get             
no overtime pay nor do they have insurance, retirement funds or                
vacations.  She noted she had a client for seven years who recently            
passed away.  After making several attempts to find his family over            
the years, she located his children in Portland, Oregon, who                   
thought he had passed away.  This client did pass away two weeks               
later after speaking to his family for the first time in 12 years.             
She repeated her request for a base rate of $100 per day with a                
sliding fee scale for clients with chronic alcohol or mental                   
illness problems.                                                              
                                                                               
Number 374                                                                     
                                                                               
DEBBIE CASK, owner of Debbie's Fireside Homes, stated she is having            
a difficult time keeping employees because she cannot compete with             
the wages offered by nursing homes.  She noted assisted living                 
facilities owners are receiving $1.44 per hour per client which is             
barely enough to buy food.  To keep employees, she needs to offer              
health insurance and competitive wages.  She recently hired three              
people from the welfare roll but had to let them go because she                
could not afford to keep them.  She said many clients need to be               
hand fed, changed daily, and turned every few hours, among other               
things.                                                                        
                                                                               
CHAIRMAN WILKEN clarified that language on lines 9-12 allows the               
department, by regulation, to provide for a daily rate higher than             
$70 if the additional care justifies the additional reimbursements.            
                                                                               
SELMA ROBINSON, owner of Robinson Care, stated at present she has              
a limited number of clients, and is concerned that the $34.50 is               
not sufficient to take care of a person in her home.  She has part-            
time help but can afford no more.                                              
                                                                               
HELEN POWELL, owner of a five-bed assisted living home, stated it              
is very difficult for her to keep her business open if she is not              
full all of the time.  She serves three meals and snacks each day,             
hires employees, pays higher utility bills, and provides an array              
of services for her elderly clients.                                           
                                                                               
Number 313                                                                     
                                                                               
MS. B JARVI, a professional guardian, stated the minimum wage is               
over $5 per hour, yet caregivers only receive $1.44 per hour which             
is an injustice.  Often she must plead with caregivers on short                
notice to take clients because they are in intolerable living                  
situations.  The assisted living facility caregivers find room for             
these clients every time and sometimes without knowing if they will            
get paid at all.  Pioneers Homes and similar facilities will not               
take people on short notice and are often full.  Ms. Jarvi said she            
could not even put a client in a hotel room for $34.50 per night,              
let alone hire someone to watch the client.  She noted when clients            
who are in the Denali Center for recuperative purposes are able to             
leave, she moves them to an assisted living facility as quickly as             
possible because the clients do better in a home environment.  They            
are treated with dignity and are included in family life.   She                
stated her support for a substantial raise to caregivers.                      
                                                                               
SHARON KENAMON, an assisted living facility owner, stated she has              
been in business for 1+ years and is barely paying her bills.  She             
is unable to provide any transportation to clients other than for              
medical visits and cannot afford to provide any activities.  Two               
clients she housed were recently released and she never received               
payment for them.  Caregivers need an increase in the pay rate in              
order to be able to provide activities for their clients.                      
                                                                               
JUDITH TOWNSEND, owner of Center of Care, stated she opened her                
facility one year ago after working as an RN in a hospital for six             
years.  She believes many people have a bad feeling about nursing              
homes, and many elderly want to stay in their own homes, so                    
assisted care facilities are the next best thing because clients               
live in a family atmosphere.  Clients often need assistance with               
daily care, but they do not have the money to pay for such care.               
The base rate of $34.50 does not cover the cost of providing for               
these clients.  Direct costs alone can run $170 per day.  She                  
believes a base rate of $100 per day would be much more appropriate            
to ensure clients receive adequate care from trained caregivers.               
                                                                               
CHAIRMAN WILKEN thanked all participants for testifying today and              
stated that although the money is an important issue, caregivers               
are motivated by more.  He thanked them for their services to a                
needy group of people.                                                         
                                                                               
DERRILL JOHNSON, Division of Mental Health and Developmental                   
Disabilities in the Department of Health and Social Services,                  
stated assisted living facilities are probably one of the most                 
important new industries in the state and are necessary as part of             
the state's long term care plan.  DHSS recognizes that the                     
compensation system needs to be revised, whether that be the fee               
structure or in the compensation methodology which determines the              
true cost of care.  DHSS would like to see the fee structure based             
on an individual's needs rather than a fixed rate.  DHSS also                  
believes a public hearing process should be held before determining            
the rate because Alaska has a variety of vendors with different                
needs.                                                                         
                                                                               
MR. JOHNSON stated the assisted living home industry is relatively             
new and is a combination of the adult foster care program and the              
adult residential care program. DHSS has been aware of problems                
that have occurred with the combination of those two programs and              
of the low rate, but it has not had the resources to adjust the                
fees to a $70 minimum.                                                         
                                                                               
CHAIRMAN WILKEN asked if a sliding fee scale based on need is used,            
whether a method to grade the needs will have to be created at an              
additional expense to the state.                                               
                                                                               
MR. JOHNSON replied that individualized funding is used with                   
developmentally disabled clients.  The cost of care is negotiated              
based on a care coordinator's plan and with an independent third               
party who works with the family of the consumer.  The necessary                
services are costed out with a vendor.  Mr. Johnson thought using              
a tiered fee schedule which allows flexibility to individualize                
each plan would work best.  In some of the outlying areas where                
assisted living facilities need further development, staff and                 
expertise may not be available to determine individually negotiated            
costs.  If a tiered system with parameters was available to use as             
a baseline to explain what costs are associated with what needs,               
caregivers could more easily determine realistic costs.  Mr.                   
Johnson said the need for quality care is the driving force behind             
assisted living facilities therefore comparable wages need to be               
paid for that care.                                                            
                                                                               
CHAIRMAN WILKEN gave the gavel to Senator Leman and excused himself            
to attend another hearing.                                                     
                                                                               
SENATOR WARD referred to Section 7 of the committee substitute and             
said he understood that section to mean that $70 is established as             
the base rate but that rate could be increased if a client requires            
extra care.  Senator Ward commented he was pleased to see this                 
legislation because this is what he came to Juneau to do, not to               
spend $120 per day to house prisoners.                                         
                                                                               
SHARON CLARK, legislative aide to Senator Mike Miller, sponsor of              
SB 321, informed committee members the two lists in committee                  
members' packets were provided by DHSS, and DHSS staff has been                
very helpful in drafting this bill.  She pointed out there are 138             
assisted living homes throughout the state.  The Alaska Caregivers'            
Association resolution contains a breakdown of the amount provided             
on a daily basis to each caregiver, compared to what each one                  
should receive.  Committee packets also contain a resolution from              
the Alaska Commission on Aging.                                                
                                                                               
MS. CLARK commented this summer she spent a lot of time speaking               
with people in rural areas about this approach.  They were excited             
about creating assisted living homes in their areas so their                   
elderly do not have to leave.  She noted many elderly are sent to              
Denali Center or other facilities in urban areas and can no longer             
see family members because the cost of travel is prohibitive.                  
                                                                               
ALISON ELGEE, Deputy Commissioner of the Department of                         
Administration, which administers the senior services programs,                
gave the following testimony.  The base rate being discussed is the            
rate for general relief funds.  Once an individual qualifies for a             
medicaid waiver,  which requires the individual to need a nursing              
home level of care, the department has the ability  to negotiate               
the amount of compensation paid to the assisted living home                    
facility.  She cautioned there will always be individuals in a                 
general relief category who do not meet the nursing home level of              
care but are incapable of living independently.  Many come through             
adult protective services and need emergency placement. The                    
department has discovered that people who move into an assisted                
living environment before their needs get to a nursing home level              
of care can generally be maintained in a less expensive environment            
for much longer.  The department's primary concern with SB 321 is              
the fiscal note because the cost of paying the base rate of $70 per            
day for existing clientele alone will be substantial.                          
                                                                               
VICE CHAIR LEMAN stated he shares Ms. Elgee's concern about how to             
address the costs, but he also shares Senator Ward's concerns.                 
                                                                               
TAPE 98-23, SIDE A                                                             
                                                                               
MONTA LANE repeated that caregivers need to receive a minimum of               
$70 per day for general relief clients in their homes, and more for            
clients who need special services.  She informed committee members             
it sometimes takes five months to get clients on a medicaid choice             
waiver.  During that time the caregiver must provide for the client            
out of pocket and is then retroactively reimbursed only to the date            
the plan of care was signed which may have occurred two months                 
after the client arrived at the home.  She added that non-profit               
organizations can get grants to build assisted living care                     
facilities but private owners get no assistance to maintain their              
homes.                                                                         
                                                                               
SENATOR WARD commented he worked on similar legislation in 1982 and            
that he will have no trouble finding enough money to fund SB 321.              
He moved to pass CSSB 321 out of committee with individual                     
recommendations and its accompanying fiscal note.  There being no              
objection, the motion carried.                                                 
SENATOR WARD informed committee members he has not yet received the            
final legislative bill on child support enforcement provisions from            
the Idaho Legislature.                                                         
                                                                               
VICE-CHAIR LEMAN announced the next HESS meeting is scheduled on               
Wednesday at 9:00 a.m.  He adjourned the meeting at 10:45 a.m.                 
                                                                               
                                                                               

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